“I smile, but Without Showing My Teeth”: The Lived Experience of Cleft, Lip, and Palate in Adults

Objective: To explore and describe the experience of growing up with unilateral cleft lip and palate (CLP) in adults. Design: Face-to-face interviews. Giorgi’s phenomenological method was used for analysis. Participants: Twenty-one (mean age: 40.8 years) adults treated for unilateral CLP during childhood and adolescence participated in the study. Results: Growing up with CLP meant to become aware of bodily otherness. The possible reactions from peers early in life complicated the striving for inclusion outside the close family. Being self-confident, clever in school, physically fit, and having trusted friends represented barriers against teasing and bullying. Nevertheless, the reflected image, in mirrors, windows, and photos, reminded the participants of the objectifying looks from others and often led to bodily adjustments that persisted into adulthood. The trajectory of treatment was not questioned during childhood, and the participants accepted the decisions on care made by experts and parents. Although problems related to the cleft could persist or return after the termination of ordinary treatment, a more hesitant view on the possible benefits of additional surgery was typical in adulthood. Conclusions: In retrospect, growing up with a unilateral CLP was found to have been an unquestioned part of the adult participants’ childhood, a burden that they feared would, to some extent, also be passed to their own children. However, the CLP had not prevented them from achieving goals and satisfaction in life. The occurrence of persisting psychological, functional, and esthetic challenges in adults suggests the need for an individualized, lifelong, and multidisciplinary perspective on CLP follow-up.publishedVersio

Understanding the course of critical illness through a lifeworld approach

An increasing number of individuals receive and survive intensive care treatment; however, several individuals experience problems afterward, which may threaten recovery. Grounded in a lifeworld approach, the aim of this study was to explore and describe what intensive care patients experience as limiting and strengthening throughout their illness trajectories. Ten former intensive care patients were interviewed three to eight months after hospital discharge. Using Giorgi’s phenomenological analysis, a general structure of gaining strength through a caring interaction with others was revealed. The structure consisted of three constituents: feeling safe through a caring presence, being seen and met as a unique person, and being supported to restore capacity. Being met with a humanistic approach and individualized care appeared to be important, and the findings are discussed within the framework of lifeworld-led care. To facilitate improved aftercare of the critically ill, more tailored support throughout the illness trajectory is needed.publishedVersio

Pain relief from nonpharmacological interventions in the intensive care unit: A scoping review

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The influence of socio-demographic and clinical factors on sick leave and return to work after open-heart surgery: a nationwide registry-based cohort study

Aims - To estimate sick leave (SL) duration after first-time elective open-heart surgery and identify factors contributing to increased SL. Methods and results - A retrospective nationwide cohort study combined data from the Norwegian Register for Cardiac Surgery and SL data from the Norwegian Labour and Welfare Administrations. All able-bodied adults who underwent first-time elective open-heart surgery in Norway between 2012 and 2021 were followed until 1 year after surgery. The impact of socio-demographic and clinical factors on SL after surgery was analysed using logistic regression and odds ratios. Of 5456 patients, 1643 (30.1%), 1798 (33.0%), 971 (17.8%), 1035 (18.9%), and 9 (0.2%) had SL of 6 months was associated with female gender, primary education only, and average annual income. Post-operative stroke, post-operative renal failure, New York Heart Association Functional Classification system (NYHA) score >3, earlier myocardial infarction, and diabetes mellitus increased the odds of SL >6 months. Conclusion - This study demonstrates that socio-demographic and clinical factors impact SL after first-time elective open-heart surgery. Patients who experience a stroke or develop renal failure after surgery have the highest odds of SL >6 months. Females and patients with low education levels, earlier myocardial infarction, or NYHA scores III–IV have a two-fold chance of SL >6 months. The findings allow for future investigations of pre- and post-surgery interventions that can most effectively reduce SL and aid return to work

The Psychological and HRQoL related Aftermaths of Extra Corporeal Membrane Oxygenation Treatment: A Cross‐Sectional Study

Objectives: To assess symptoms of post-traumatic stress disorder, anxiety, depression and health related quality of life in a sample of adult patients treated with veno-arterial extracorporeal membrane oxygenation. Design and setting: This is a cross-sectional study. The population were all patients discharged (2008–2018) from a thoracic surgical intensive ward at a tertiary university hospital in Norway. A sample of 20 patients was recruited. Main outcome measures: Symptoms of post-traumatic stress disorder were assessed using Impact of Events Scale-Revised, while symptoms of depression and anxiety were assessed using Hospital Anxiety and Depression Scale. RAND 36-Item Short Form Health Survey was applied to measure health-related quality of life. Results: Symptoms of post-traumatic stress disorder were reported by 40% of the participants. Twenty percent reported symptoms of depression and anxiety. Compared to the general population, participants reported poorer health-related quality of life on all domains, and significantly worse on the domains physical function, general health and social function. Conclusion: Patients in our study reported symptoms of post-traumatic stress disorder, anxiety, depression and impaired health-related quality of life following treatment with veno-arterial extra corporeal membrane oxygenation. Addressing possible emotional and psychological distress could represent a potential major improvement in health care provided to this group. Further research is needed to incorporate prophylactic methods, such as identifying vulnerable patients and implement corresponding interventions, into clinical practice.publishedVersio

“Finding oneself after critical illness”: voices from the remission society

Under embargo until: 2021-10-07The number of people who survive critical illness is increasing. In parallel, a growing body of literature reveals a broad range of side-effects following intensive care treatment. Today, more attention is needed to improve the quality of survival. Based on nine individual stories of illness experiences given by participants in two focus groups and one individual interview, this paper elaborates how former critically ill patients craft and recraft their personal stories throughout their illness trajectory. The analysis was conducted from a phenomenological perspective and led to the meaning structure; a quest to find oneself after critical illness. In this structure, illness represented a breakdown of the participants’ lives, forcing them to develop a new understanding of themselves. Despite acute illness, they felt safe in hospital. Coming home, however, meant a constant balancing between health and illness, and being either in or out of control. To gain a deeper understanding of the participants’ narratives of survival, the meaning structure was developed from a phenomenological life world perspective, Heidegger’s concept of homelikeness and Arthur Frank’s typologies of illness narratives. In conclusion listening to and acknowledging the patients’ lived experiences of critical illness may support the patient efforts to establish the newly defined self and hence be vital for recovery. Phenomenology is one approach facilitating care tailored to the patients’ lived experience of critical illness and its aftermaths.acceptedVersio

Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation

Background The World Health Organization’s Global Patient Safety Action Plan 2021–2030 call for attention to patient and family involvement to reduce preventable patient harm. Existing evidence indicates that patients’ involvement in their own safety has positive effects on reducing hospitalisation time and readmissions. One intervention reported in the literature is the use of checklists designed for patients’ completion. Studies on such checklists are small scale, but they are linked to reduction in length of hospital stay and readmissions. We have previously developed and validated a two-part surgical patient safety checklist (PASC). This study aims to investigate the feasibility of the PASC usage and implementation prior to its use in a large-scale clinical trial. Methods This is a prospective cross-sectional feasibility study, set up as part of the design of a larger stepped-wedge cluster randomised controlled trial (SW-CRCT). Descriptive statistics were used to investigate patient demographics, reasons for not completing the PASC and percentage of PASC item usage. Qualitative patient interviews were used to identify barriers and drivers for implementation. Interview was analysed through content analysis. Results Out of 428 recruited patients, 50.2% (215/428) used both parts of PASC. A total of 24.1% (103/428) of the patients did not use it at all due to surgical or COVID-19-related cancellations. A total of 19.9% (85/428) did not consent to participate, 5.1% (22/428) lost the checklist and 0.7% (3/428) of the patients died during the study. A total of 86.5% (186/215) patients used ≥ 80% of the checklist items. Barriers and drivers for PASC implementation were grouped into the following categories: Time frame for completing the checklist, patient safety checklist design, impetus to communicate with healthcare professionals and support throughout the surgical pathway. Conclusions Elective surgical patients were willing and able to use PASC. The study further revealed a set of barriers and drivers to the implementation. A large-scale definitive clinical-implementation hybrid trial is being launched to ascertain the clinical effectiveness and scalability of PASC in improving surgical patient safety.publishedVersio

Development and validation of patients' surgical safety checklist

Background Poor uptake and understanding of critical perioperative information represent a major safety risk for surgical patients. Implementing a patient-driven surgical safety checklist might enhance the way critical information is given and increase patient involvement in their own safety throughout the surgical pathway. The aim of this study was to develop and validate a Surgical Patient Safety Checklist (PASC) for use by surgical patients. Method This was a prospective study, involving patient representatives, multidisciplinary healthcare professionals and elective surgical patients to develop and validate PASC using consensus-building techniques in two Norwegian hospitals. A set of items intended for PASC were rated by patients and then submitted to Content Validation Index (CVI) analyses. Items of low CVI went through a Healthcare Failure Mode and Effect Analysis (HFMEA) Hazard Scoring process, as well as a consensus process before they were either kept or discarded. Reliability of patients’ PASC ratings was assessed using Intraclass Correlation Coefficient analysis. Lastly, the face validity of PASC was investigated through focus group interviews with postoperative patients. Results Initial development of PASC resulted in a checklist consisting of two parts, one before (32 items) and one after surgery (26 items). After achieving consensus on the PASC content, 215 surgical patients from six surgical wards rated the items for the CVI analysis on a 1-4 scale and mostly agreed on the content. Five items were removed from the checklist, and six items were redesigned to improve PASCs’ user-friendliness. The total Scale-level index/Average (S-CVI/Ave) before revision was 0.83 and 0.86 for pre- and post-operative PASC items, respectively. Following revision, these increased to 0.86 and 0.93, respectively. The PASC items reliability score was 0.97 (95% confidence interval 0.96 to 0.98). The qualitative assessment identified that patients who used PASC felt more in control of their situation; this was achieved when PASC was given to them at what they felt was the right time and healthcare professionals took part in its usage. Conclusion Multidisciplinary perioperative care staff and surgical patients agreed upon PASC content, the checklist ratings were reliable, and qualitative assessment suggested good face validity. PASC appears to be a usable and valid checklist for elective surgical patients across specialties.publishedVersio

Helsesykepleieres erfaringer med forebygging av brannskader hos småbarn

Bakgrunn: Brannskader hos barn er et globalt folkehelseproblem. Spesielt utsatt er barn 0-4 år. Helsesøstres erfaringer med å forebygge brannskader fra et kommunebasert brannskadeforebyggende program vil bidra til en dypere forståelse av forebygging av brannskader. Hensikt: Å utforske og beskrive helsesøstres erfaringer med forebygging av brannskader hos småbarn. Metode: Studien har en kvalitativ metode med ett eksplorerende og induktivt design. Det ble foretatt et strategisk utvalg av helsesykepleiere fra en kommune godkjent som «Trygt lokalsamfunn». Totalt 11 helsesykepleiere fra helsestasjonstjenesten deltok i to fokusgruppeintervjuer og ett individuelt intervju. For analyse av data ble det benyttet en kvalitativ innholdsanalyse. Resultat: Helsesykepleieres erfaringer med forebygging av brannskader innebærer «å møte foreldre med individuell tilpasning», «å styrke foreldrerollen» og «å tilhøre et fellesskap med felles visjoner og mål for brannskadeforebygging». Det ble identifisert et felles hovedtema: «Forebygging av brannskader oppleves som et moralsk ansvar». Konklusjon: Det brannskadeforebyggende arbeidet bør i større grad tilpasses individuelt og der kulturelle hensyn bør tas ved planlegging, etablering og gjennomføring av brannskadeforebyggende tiltak. Individuell tilpasset informasjon med empowerment-tilnærming kan styrke familier i deres behov for økt kunnskap og kompetanse. Samhandling mellom spesialist- og primærhelsetjenesten, frivillige og private aktører vil forsterke det brannskadeforebyggende arbeidet

Etterlattes erfaring med intensivdagbok når pasienten dør

Bakgrunn: Akutt og kritisk sykdom som krever innleggelse på en intensivavdeling, er en stor belastning både for pasienten og de pårørende. Intensivpasienter kan ha mangelfulle minner fra tiden på intensivavdelingen, og sykepleiere har derfor skrevet dagbøker til dem. Når pasienten dør på en intensivavdeling, får de etterlatte tilbud om å få dagboken. Hittil er det lite kunnskap om etterlattes erfaringer med å motta dagbok. Hensikt: Å få mer kunnskap om etterlattes erfaringer med å motta intensivdagbok etter at pasienten er død. Metode: Studien har en kvalitativ tilnærming som er fenomenologisk. Etterlatte ble invitert fra tre ulike intensivavdelinger ved et norsk universitetssykehus. Vi gjennomførte dybdeintervju med fem etterlatte 6–18 måneder etter at pasienten var død. I tillegg inkluderte vi en skriftlig e-post fra en deltaker. Intervjuene ble tatt opp på lydl og transkribert ordrett. Vi utførte analysen ved hjelp av Giorgis deskriptive fenomenologiske metode. Resultater: Alle de etterlatte i studien var rammet av sorg. Dagboken var etterlengtet og ble brukt til trøst og støtte. Det å motta dagboken frembrakte også sterke følelser, men ingen ville likevel ha vært den foruten. Enkelte skulle ønske at dagboken hadde blitt utlevert tidligere. Bildene opplevdes som sterke og verdifulle. Når de etterlatte leste i dagboken, ble sykepleiernes omsorg for deres kjære tydelig, noe som betød mye for dem. Dagboken bidro til å strukturere en kaotisk tid og gjorde det mulig å ventilere følelser. Konklusjon: Når pasienten dør på en intensivavdeling, kan intensivdagbøker støtte etterlatte i sorgprosessen